RESUMO
Resumen La infección por Strongyloides stercoralis es una parasitosis frecuente en las regiones tropicales y subtropicales, incluyendo la Amazonía peruana. En pacientes con inmunocompromiso, las manifestaciones clínicas son variadas y es frecuente la diseminación sistémica de la enfermedad, con compromiso de diversos órganos. Las manifestaciones cutáneas son infrecuentes y se describen en pacientes con algún grado de inmunosupresión. Se presenta el caso de un paciente inmunocompetente que desarrolló una púrpura reactiva por una infección por Strongyloides stercoralis crónica. Ante ello, es posible el compromiso cutáneo en pacientes inmunocompetentes con reagudización sistémica por este parásito.
Infection with Strongyloides stercoralis is a common parasitic infection in tropical and subtropical regions, including the Peruvian Amazon. The clinical manifestations are varied in patients with immunocompromised disease, and the systemic spread of the disease is frequent, compromising different organs and systems. Cutaneous manifestations are infrequent, being described in patients with some degree of immunosuppression. We present the case of an immunocompetent patient who developed a reactive purpura due to chronic Strongyloides stercoralis infection. Thus, skin involvement is possible in immunocompetent patients with systemic exacerbation due to this parasite.
Assuntos
Humanos , Animais , Masculino , Adulto , Adulto Jovem , Púrpura/etiologia , Púrpura/imunologia , Estrongiloidíase/complicações , Estrongiloidíase/imunologia , Púrpura/tratamento farmacológico , Ivermectina/uso terapêutico , Clorfeniramina/uso terapêutico , Hospedeiro Imunocomprometido , Strongyloides stercoralis/isolamento & purificação , Antiparasitários/classificação , Antiparasitários/uso terapêutico , Antipruriginosos/uso terapêuticoRESUMO
Cutaneous manifestations in disseminated strongyloidiasis are infrequent but should raise the suspicion for its diagnosis. We retrospectively evaluated the charts of six patients with cancer and a proven diagnosis of disseminated strongyloidiasis. All patients had received prophylaxis with albendazole before starting antineoplastic therapy, which included high-dose steroids. They presented with septic shock, acute respiratory failure and characteristic purpuric periumbilical skin lesions. Strongyloides larvae were identified in tracheal aspirates (n=5), gastric aspirates (n=4), lung (n=2) and skin biopsies (n=2). All patients died despite antihelminthic therapy and intensive care support.
Assuntos
Adulto , Idoso , Animais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/parasitologia , Neoplasias/patologia , Púrpura/patologia , Dermatopatias Parasitárias/patologia , Strongyloides stercoralis/isolamento & purificação , Estrongiloidíase/patologia , Anti-Helmínticos/uso terapêutico , Biópsia , Evolução Fatal , Hospedeiro Imunocomprometido , Neoplasias/imunologia , Púrpura/imunologia , Púrpura/parasitologia , Dermatopatias Parasitárias/complicações , Pele/parasitologia , Pele/patologia , Estrongiloidíase/complicações , Estrongiloidíase/tratamento farmacológicoRESUMO
We present a case of papular-purpuric "gloves and socks" syndrome (PPGSS) in an adult male with acute parvovirus B19 infection. The patient displayed the classical features of fever, oral lesions, and purpura on hands and feet, but the purpuric lesions on the feet evolved to superficial skin necrosis, a feature not previously described in this syndrome. We believe this is the first reported case of PPGSS occurring in Brazil